Acquired Heart Disease in Pregnancy: Assessing Maternal and Perinatal Outcome

1. Acquired Heart Disease in Pregnancy: Assessing Maternal and Perinatal Outcome Eliza M.N (1), Quek Y.S. (1), Woon S.Y. (1), Ravichandan N. (2), Ravichandran J. (1) 1. Hospital Sultanah Aminah Johor Bahru, Malaysia 2. Singapore General Hospital OPTIONALLOGO HERE OPTIONALLOGO HERE Objectives Results Results Conclusions Our study provides a contemporary assessment of maternal and neonatal risk associated with pregnancy in women with heart disease who are receiving comprehensive prenatal care. The cardiac event rate in our study was also lower compared to previous study. The neonatal mortality rate and preterm labour was also lower compared to previous studies as well. Poor NYHA class was predictive of neonatal events or pretem labour as these patients were more likely to require delivery or induction at an earlier gestation. Patients with acquired heart disease in pregnancy is able to have a good pregnancy and perinatal outcome if they are followed up well under a multidisciplinary team involving the cardiologist and obstetrician. They are able to reach term with few complications The prevalence of maternal heart disease during pregnancy is estimated at 0.5-1% and is increasing. Rheumatic heart disease is most prevalent in developing countries and most of these patients are detected to have heart disease once embarking on their pregnancy. Pregnancy induces haemodynamic changes ( increased intravascular volume and cardiac output, decreased systemic vascular resistance and hypercoaguble state) which are associated with increased risk for mother and foetus when maternal heart disease is present. This study is to assess the maternal and perinatal outcome in patients with acquired heart disease. Table 1. Demographic characteristics of study group As for the perinatal outcome, 14 of the babies required admission to NICU and 5 of these admissions were due to prematurity. There was only 1 case noted to have ventriculomegaly secondary to warfarin treatment . The mean APGAR SCORE was 8.8 and the mean birthweight achieved was 2.9kg (Table 4). Table 3. Obstetric Outcomes of study group Data presented as mean ± SD or n (%). Table 2. Heart disease and cardiac event in study group Methods Prospective observational study in 89 pregnant women diagnosed with having acquired heart disease for 1 year duration These patients were managed by the combine obstetrician and cardiologist. The demographic data of the patients was observed.Patients were monitored throughout their pregnancy and their outcomes, cardiac event , mode of delivery, intrapartum event and perinatal outcome were observed and recorded. Data presented as n (%) or mean ± SD. Table 4. Neonatal Outcomes Characteristics of study group References 1. Jastrow N, Meyer P, Kahiry P, et al. Prediction of complications in pregnant women with cardiac diseases referred to a tertiary center. Int. J Cardiol 2011;151:209-213. 2. Ruth C., Swan L., Steera PJ. Cardiac disease in pregnancy. Curr Opinion Obstet Gynecol 2009;21:508-513. 3. Willem D., Eric B., Balci A., et al. Predictors of pregnancy complications in women with congenital heart disease. European Heart J 2010;31:2124-2132. 4. Samuel CS, Sermer M, Colman JM, et al. Prospective Multicenter Study of Pregnancy Outcomes in Women with Heart Disease. Am Heart Assoc Circulation 2001; 104:515-521. 5. Paul K., Ouyang DW., Fernandes SM., et al. Pregnancy Outcomes in Women with Congenital Heart Disease. Am J Heart Assoc 2006; 113:517-524. Data presented as mean ± SD or n (%). Results Data presented as n (%). The majority of patients were from the malay ethnicity and this may be contributed from the fact that they are the highest population in the country (Table 1). Majority of our patients had chronic rheumatic heart disease. Type of acquired heart disease and occurrence of cardiac events were stated in Table 2. Majority of patients were delivered vaginally. There were 4 cases complicated with post-partum haemorrhage required blood transfusion (Table 3).